John Q (2002, DVD)

For a movie that gets right to the heart of our country s health care system s biggest problems, it is going to be hard to beat this one. If you are wondering what all the hullabaloo is about, because you, as yet, have not had to face an uninsured catastrophic illness, I urge you to watch this movie.

And before you say with a nervous sideways glance, Aw...that couldn t happen HERE!...I assure you that on every level but the happy ending, it could. The issues will keep this movie from popular acclaim, because we have proven time and again that when it comes down to it, we don t want to hear about the really bad things. In fact, if it doesn t affect us personally, we don t want to hear about it at all. Or perhaps more significantly, in spite of the fact that this movie grossed 27 million dollars in its opening weekend, powerful critics have kept the publicity way down on this one.
This film, which deals with a working man s plight to keep his son alive, is a no frills head on attack at a system of care that fails to care. And I will try to stay off the soapbox. ( I will find it difficult.)


Unfortunately this movie does have to be put into the category of fantasy, because there are too many coincidences to be credible. While I believe in miracles, a Hollywood miracle such as the one in this movie, is tighter than I can stretch my faith. It may be in the long run, the flaws in this movie that I remember, in spite of the intent of the director, which was undoubtedly a good one. A little more research from the care giver point of view would have helped. But for the sake of those who want me to get on with it, I ll save my medical reality check for last, and you can feel free to skip it.

In terms of basic film elements, such as cinematography, directing and dialog, all are better than average. The photography checks in as industry standard, with some nice touches in palette limiting, and set design, the music works for the movie. It is the first score written by Aaron Zigman, and it brings an otherworldly quality to the film which might otherwise be lost. The dialog is actually better than average. Many of the things that needed to be said, were said. And while it is cue-card obvious to the audience,( whom the director doesn t trust to get it on its own), it is at least straightforward. In one example, the emergency room doctor lays it all out. (Although it isn t the whole story, it is part of it.)

The cast for this movie was well chosen, and stellar. Denzel Washington immersed himself completely in his character as did Kimberly Elise. Washington s performance as the father willing to do anything to save his son, was outstanding... Or perhaps his usual fans, me included, were so happy to see him return as a good guy after Training Day, we are blind to his faults. Because I looked and could find no fault. It is a sensitive and wonderful portrayal of a man who loves his son very much. In any case, he got my sympathy from the very start.

The other three exceptional characters in the cast, although there were really NO bad performances here, were James Woods as the Cardiac surgeon, and Robert Duvall as the hostage negotiator and Anne Heche as the hospital administrator. Ray Liotta is in this movie also, and plays a surprisingly dim-witted police chief. Anne Heche plays the cold hearted hospital administrator, and gives an interesting performance in a complex role, the only one that comes off with any real internal conflict.

For Cassevetes the director, (and you may remember him better in Face/Off as the brother of Sasha, Dietrich Hassler,) this will be his third feature film, although he has written a lot, and acted in many films in the past. It is certainly his most interesting film to date. The first Unhook the Stars, in 1996, was dedicated to his father, the second , She s so Lovely , in 1997 is dedicated to his mother, and this one to his daughter, (Sasha) who had problems similar to the ones experienced by young Mike Archibald. Knowing that this movie is wrenched from the personal experience of the director allows for some forgiveness of details that just don t seem right , because the point of view changes substantially when you realize that you are participating (as the victim) in this event, not merely watching it. The writing credits for the screenplay go to James Kearns, and the idea came from a rich transplant patient saying after his transplant, If I didn t have money, I would be dead now.

THE PLOT

The movie opens with an accident, high in mountains, involving a girl, a car and two Mack trucks. Remember it.

Now we meet the Archibalds, a struggling black family trying to make it in a blue collar world, where the economy is in the hole. The family car is being repossessed by the bank. John Q has been cut to 20 hours, Denise has taken a job as a waitress in a restaurant, and young Mikey is blissfully unaware, secure in the love of his immediate family and friends.

The family goes to church, and engages in the usual family activities. And they struggle, but that doesn t differentiate them from so many others, although there is an undercurrent of desperation already present. Then one day, Mikey is sliding into second base at a little league game, and he drops unconscious. They rush him to the ER.

The family is faced with the news that their son, previously healthy, is desperately ill with an undiagnosed heart condition present at birth. But suddenly, his heart can no longer carry the load, and he needs a transplant, or he will die. This news is delivered by the hospital administrator Rebecca Payne, and Dr. Turner, the cardiac surgeon. But John is not worried. He has always paid the full premium at work for full coverage insurance. The administrator is the realist, and also has done some checking. She advises them to take Mikey home and make him comfortable, and let him die.


John Q finds out first that when the company cut his hours, they also cut his benefits (but forgot to tell him) . The hospital officially lists him as a money paying patient, and refuse to put Mikey on a list for potential donors. Despite contributions from everyone, church and friends, and selling everything they own, they can t raise near the cash they need for this operation. They do not qualify for Medicaid. John Q has just sold has truck, as the last thing of value that he possesses, and Denise calls him, screaming at him to do something. The administrator plans to boot Mikey out of the facility to go home to die, in the morning.

Desperate, John Q comes to the hospital, and corners the doctor, who glibly begs off the administrator s decision. John Q takes him hostage in the Emergency room, threatening to kill someone unless his boy is able to receive the transplant he needs to live.

I won t take you any farther than that. There are some interesting twists to this story, and you need to experience them for yourself. There are several recognizable heroes in this potential disaster.


This is my favorite line in the movie delivered by Lester Matthews, another patient in the emergency room:

Hippocratic Oath?-more like the hypocritical oath- I solemnly swear to take care of the sick damn near dyin unless they ain t got major medical-or somethin like that, ain t that it doc?



MEDICAL REALITY CHECK

1. Pregnant people in the ER-I have never worked in a single hospital where a woman in labor would be checked by anyone in the ER. The usual procedure treats women in labor like patients with a contagious illness . They take them up to OB, no matter what. It is expected and predicable.

2. Although the director said his own experience with his daughter was different, patients who are intubated do not talk out loud. I have never seen one that could, no exceptions.

3. The operation itself was simplistically depicted, but remember we are going by the director s searing memory of such an event.

4. It is unbelievable that the hospital administrator and the doctor would offer hope of a transplant operation, to a family for whom it was not an option. Now a second opinion might have been sought, but you don t offer the hope of something you cannot provide. I have never seen that done.

5. There is a lot of truth in the getting around the laws in the emergency room statement, to transfer patients to other facilities, despite COBRA laws. Patients have to be stabilized before they transport, but there is no question that there are two levels of care given, for the insured versus the uninsured, and even tiers of care offered depending on the type of insurance. In one hospital where I worked, epidural anesthesia was only offered to patients who pre-paid the anesthesiologist. I got that changed by appealing to a licensing board, but lost my job over it.

6. The heart condition (3 septal defects and myopathy) is what I found hardest to believe is that Mikey lived a symptom free life for 7 years , with the serious diagnosis of septal defect and congestive heart failure, until he collapsed on the baseball field. While I can believe the deliberate non-diagnosis (I have seen it, and know it can happen) , I can t believe the symptoms would not have asserted themselves before this time. In fact, babies with this type of heart usually manifest symptoms hours after birth, and most within the first year when corrective surgery is still possible. If nothing else, other things, such as failure to grow normally, and weakness, shortness of breath, and all sorts of other symptoms would be present.

7. The miracle of the donor is the hardest to accept, since there are so many people waiting for transplants. The problem really is, who gets first choice. I am willing to accept this as a miracle for this movie though.

8. Transplant patients are generally in a long term care situation for a long time, and donor matches with the parent are possible, but again, seem a little too easy for John Q s plan-and simplistic solution to the problem.

9. There are details about the surgery and procedures that even I know are simplified versions of the real thing, but I guess you don t really have to concern yourself. I like for the technical details to be correct.

THE CAST

Gabriel Oltean as the beautiful woman, who drives on mountain roads with her brain in a distant galaxy, protected only by her rosary beads. The connection is made through the use of choir like singing, and music, not to mention religious symbolism out the wazoo, to a miracle , that her heart would be available for transplant, by virtue of her stupidity in passing Mack trucks on a mountain road. That this was going to happen, is given, from the opening credits, so there are no secrets here.

Denzel Washington as John Quincy Archibald (hence the title, which in an alternative interpretation, is "Mr. Everyman" A.K.A. John Q. Public ) . Denzel is immersed into his role as a blue collar worker. He is a hard worker, and working less, due to a down shift in the economy, where his hours were cut, as well as his insurance benefits, which of course, the company failed to tell him, until he went to claim his benefits. His character shows two things, first that by and large, we just don t know how the system works until we need to use it, and second, that the things that American Workers used to take for granted, and were assured, are no longer assured. Insurance companies have clauses for things they won t cover, procedures they consider elective, and procedures which will not be paid . He also finds that there is more to applying for medical assistance than NEED. If you make even as much as $550 dollars a month, you don t qualify. And third, no matter how generous your friends, and your community it will be but a drop in the bucket compared to the cost of the illness. Most of us will find this out when we grow out of the flush of youth, and the security of relatively good health. This character gets his reality check early. It is an amazing confrontation of man against the system. And even if the heroism is impossible, it was still good to see the little man for once, triumph.

Kimberly Elise-as Denise Archibald, as the frazzled wife and mother, working in a supermarket to make ends meet, and already faced with their loss of security (her car is repossessed in the second scene in the movie)before the illness. She plays it well, as a loyal wife, and desperate mother, and her performance was touching, and quite believable.

Daniel E. Smith as Mike Archibald. A very cute little boy, who also plays his part well, as a kid, before his illness was a loving son, who lived the life of a seven year old having the security of a loving family that protected him from the worries and concerns of his parents-as it should be. He achieves an almost ethereal calm as he gets sicker and sicker. The most uplifting aspect of the movie is his final scene where the old personality is briefly reasserted.

David Thornton as Jimmy Palumbo, John Q s best friend and factory worker. If you want tio hear the working man s plight put into words listen to this character. He is a regular in Cassevetes three films, and his one very succinct speech (ad libbed in front of the camera) is shown on a TV segment, where the crowd its interviewed. It was a brilliant and moving piece of work. He is also interesting because he is always angry, always mistrusts the bosses and the system-unlike John Q. who believes the system will ultimately work for him, until he finds out differently.

Laura Harring as Gina Palumbo-she really has little to say, as many wives of working class guys have little to say.

Eddie Griffin as Lester Matthews. This character is another character with class, a patient already in the emergency room when John Q makes his move. He gives the best version of the Hippocratic oath as administered by HMOs. He also adds a little necessary humor into this otherwise very serious look at a devastating problem.

Ethan Suplee as Max Conlin the security guard. He was the fat kid in Remember the Titans, and his role here is actually pretty likable as the security guard in the ER who becomes an ally when he understands what is going on.

Rick Sood as ER doctor-he is an interesting character, possibly the hope of a new generation of doctors, who understand all too well the cold injustice of the health care system, especially as administrated by HMOs. He is a fairly well developed character, even with his relatively limited exposure, and well done . (Turner calls him a 'communist' in one deleted scene)

Shawn Hatosy as Mitch Quigley-not a likable character, the one antagonist in the group of patients needing care. He played the part so well that NO one will like him in this movie. He beats his girlfriend, and considers his own needs above all others, never showing any sympathy for the plight of the others. Everyone cheers when his girlfriend gets even.

Heather Wahlquist as Julie Berg-a very interesting performance of my favorite character in the movie. She starts out insolent, the compliant girlfriend of the arrogant rich kid, and acts as we wish all battered women could be empowered to act. She too is a hero, of sorts. And I will remember her performance as one of the most unexpected and gratifying in the movie!

Robert Duvall as Lt Frank Grimes-this is the policeman with experience, who is himself in need of a little education about humanity. Duvall plays it straight as the hostage negotiator until his boss cuts him out of the picture. He later resumes his status as head negotiator, and brings the episode to a close. Duvall is a class act. He can play any role, and does it well.

Ray Liotta as Chief Monroe-I thought this was a comic performance and intended to be so. He is there just to give Duvall someone to yell and blow off steam, but it is done with that political, glib charm that such a character would inevitably show in such a situation, and Liotta does so well.

Larissa Laskin as Dr. Ellen Klein-a smaller role, but she is one of the people able to actually communicate with John Q, and is obviously sympathetic to his plight.

James Woods as Dr. Raymond Turner-this is a pivotal role, but probably not the role you expect. He is the cardiac surgeon, the genius who does the transplants. Yet he is the one taken hostage, and whose cooperation will be the turning point in the movie. Woods was great as the slightly boastful character, who we sense is hiding behind his affability. His greatest desire is just to perform the surgery. He really doesn t want to have to deal with the reality of the health care system, and as the great surgeon, he rarely has to. As I said, his changes are important to note, and he becomes a pretty sympathetic character by the end.

Anne Heche as Rebecca Payne-This has got to have been the hardest role to play of any. The administrator DOES have to make the tough choices, but they don t get into that position with that kind of authority if they can t make them. She is cold, and everyone hates her. She is about to send the young boy home to pay, because she knows the Archibalds don t have the insurance to cover the transplant. She will not even put the boy s name on the transplant list. But all may not be exactly as it seems so wait until the end of the movie before you dismiss her. I was impressed.


FINAL RECOMMENDATION

I think this movie is worth watching, if only because the Insurance Conglomerates are protesting it so vehemently. I think you can forgive some of the technicalities to accept the more important message, and enjoy the superb performances of a well chosen cast.